Internalizing Pathways to Adolescent Substance Use from Adverse Childhood Experiences

The mediating role of anxious, depressive, and somatic symptoms was examined in the association between adverse childhood experiences (ACEs) and adolescent substance use, with attention to the unique effects of each set of symptoms within the same model. Adolescents (n = 701) were assessed over time (ages 3-17) in a majority male (70.5%) and white (89.9%) sample. Findings indicate that depressive symptoms mediated the association between ACEs and adolescent cigarette and marijuana use. Although significant indirect effects remained when accounting for externalizing behavior, a novel protective pathway emerged through parent-reported youth anxiety and alcohol use. Assessing internalizing symptoms as separate facets within the same model is critical if we are to inform prevention programs that are tailored to the individual needs of youth who have experienced ACEs.